title: Minute ventilation during spontaneous breathing, high-intensity noninvasive positive pressure ventilation and intelligent volume assured pressure support in hypercapnic COPD.
abstract: BACKGROUND
  High-intensity noninvasive positive pressure ventilation (HI-NPPV) is an effective treatment option in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). However, the effect of HI-NPPV compared with spontaneous breathing (SB) on minute ventilation (MV) in patients receiving long-term treatment remains to be determined. This study compared MV during HI-NPPV and SB. In addition, the ability of intelligent volume assured pressure support (iVAPS) to increase MV to the same extent as HI-NPPV was determined.
  
  
  METHODS
  Daytime pneumotachographic measurements were performed during SB, HI-NPPV and iVAPS.
  
  
  RESULTS
  Twenty-seven stable hypercapnic COPD patients (mean FEV1 34 ± 15% predicted) who had been treated with HI-NPPV for a median of 22 months (interquartile range 8.5-84 months) were enrolled. Mean MV was 9.5 ± 1.7 L/min during SB and 12.1 ± 2.8 L/min during HI-NPPV, an increase of 2.5 L/min (95% CI [1.5-3.6] p < 0.001), or 26%. MV during iVAPS was 11.7 ± 3.6 L/min, an increase of 1.8 L/min (95%CI [0.7-3.0], p = 0.003) compared with SB. There was no difference in MV between HI-NPPV and iVAPS (p = 0.25).
  
  
  CONCLUSIONS
  Long-term HI-NPPV increased MV by an average of 26% compared with SB in stable hypercapnic COPD patients. A similar increase in MV was observed during use of iVAPS.
authors.affiliation: 1Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital , Ostmerheimer Strasse 200, D-51109 Cologne , Germany.
authors.forename: Emelie
authors.initials: E
authors.lastname: Ekkernkamp
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Kabitz
authors.forename: David J
authors.initials: DJ
authors.lastname: Walker
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmoor
authors.forename: Jan H
authors.initials: JH
authors.lastname: Storre
authors.forename: Wolfram
authors.initials: W
authors.lastname: Windisch
authors.forename: Michael
authors.initials: M
authors.lastname: Dreher
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D059725:Interactive Ventilatory Support / Q000379:methods; D008168:Lung / Q000503:physiopathology*; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods; D009765:Obesity / Q000150:complications; D011175:Positive-Pressure Respiration / Q000379:methods; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012123:Pulmonary Ventilation / Q000502:physiology*; D012119:Respiration